Racial/ethnic and socioeconomic disparities in the quality of care and outcomes of patients with diabetes have been widely documented, yet relatively little is known about how to reduce these differences. In particular, innovative, sustainable models to improve regional diabetes care are desperately needed that take into account the cultural, racial, organizational, and economic realities of the urban health setting. Previously the investigators have systematically identified gaps in the literature regarding effective interventions to reduce diabetes disparities. This proposal seeks to address these knowledge gaps in an innovative, sustainable way that can be replicated in other areas of the country. The primary goal is to test whether a multi-factorial intervention can improve the quality of care and outcomes of diabetes patients living in predominantly low- income African-American communities, through collaboration between community health centers, an academic medical center, and community-based organizations. The Specific Aims are: 1) To test the effectiveness of a collaborative model program implemented within six clinics on the South Side of Chicago on the quality of diabetes care and outcomes. This multi-factorial intervention incorporates culturally tailored patient activation, cultural competency and communication training for clinicians, and clinic redesign with patient advocates, a quality improvement collaborative, care management, and enhanced community partnerships. The intervention also seeks to increase the number of persons with diabetes from underserved populations who access comprehensive care in safety net health centers through patient advocates and partnerships with community- based organizations. 2) To identify the costs of intervention implementation from the business case perspective of the outpatient clinics and from a societal perspective. 3) To determine the major barriers and solutions to successfully implementing this regional intervention. The study team has expertise in outcomes research, culturally tailored behavioral change, cultural competency training, regional quality improvement collaboratives, race studies, economic analyses, organizational theory, and community-based participatory research. PUBLIC HEALTH RELEVANCE: Innovative, sustainable models to improve regional diabetes care are desperately needed that take into account the cultural, racial, organizational, and economic realities of the urban health setting. This proposal seeks to address acknowledged gaps in an innovative, sustainable way that can be replicated in other areas of the country. The primary goal is to test whether a multi-factorial intervention can improve the quality of care and outcomes of diabetes patients living in predominantly low-income African-American communities, through collaboration between community health centers, an academic medical center, and community-based organizations.